Provider Demographics
NPI:1053380717
Name:JEFFERSON COUNTY PATIENT CARE SERVICES
Entity type:Organization
Organization Name:JEFFERSON COUNTY PATIENT CARE SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:D
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MPH
Authorized Official - Phone:636-797-4913
Mailing Address - Street 1:10679 HIGHWAY 21
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:MO
Mailing Address - Zip Code:63050-5094
Mailing Address - Country:US
Mailing Address - Phone:636-797-4913
Mailing Address - Fax:636-797-5876
Practice Address - Street 1:10679 HIGHWAY 21
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:MO
Practice Address - Zip Code:63050-5094
Practice Address - Country:US
Practice Address - Phone:636-797-4913
Practice Address - Fax:636-797-5876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO263-18251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO105406OtherBLUE CHOICE
MO6000023OtherUHCMCC
MO105406OtherBLUE CROSS NON-ALLIANCE
MO105406OtherBLUECROSS
MO105406OtherBLUE CROSS ALLIANCE
MO105406OtherBLUE CROSS FEDERAL
MO=========OtherUNION PACIFIC
MO105406OtherBLUE CROSS NON-ALLIANCE
MO=========OtherPROVIDE INFUSION
MO105406OtherBLUE CROSS FEDERAL
MO=========OtherVAC
MO=========OtherAIG
MO105406OtherBLUECROSS
MO=========OtherAPRIA
MO6000023OtherUHCMCC
MO=========OtherCHAMP VA
MO=========OtherUHC SELECT
MO=========OtherGENTIVA
MO=========OtherGENTIVA